Contaminated Cocaine Triggering Skin Death, Infection

24 Jun Contaminated Cocaine Triggering Skin Death, Infection

Cocaine that has been contaminated with a de-worming drug commonly used by veterinarians seems to be causing a skin disorder in cocaine users. Purpura, a condition that causes crusty, purplish areas of dead skin that are extremely painful and can lead to severe infections, has been associated with contaminated cocaine in several cases.

The de-worming drug, called levamisole, was found in 30 percent of confiscated cocaine in 2008 and in 70 percent of cocaine in 2009, according to the U.S. Drug Enforcement Administration. Purpura can also be caused by a range of rare diseases, but physicians have linked it to levamisole-contaminated cocaine in eight cases.

In the Journal of the American Academy of Dermatology, physicians highlight six new cases of purpura, mostly on and around the ears, that are associated with cocaine use. The cases (four in Rochester, New York, and two in Los Angeles, California) are similar to two additional cases in San Francisco that were previously reported in the journal. In all cases, blood tests ruled out the typical causes of purpura.

Researchers from the University of Rochester Medical Center and the University of California, Los Angeles, note that although they cannot say for sure that cocaine use is the direct cause of purpura in these cases, the striking similarity of these cases and the presence of another condition caused by levamisole strongly point to contaminated cocaine as the culprit.

The authors said that the cases of skin reactions and illnesses linked to contaminated cocaine are just the beginning of a public health problem caused by levamisole.

Mary Gail Mercurio, M.D., study author and associate professor in the Department of Dermatology at the University of Rochester Medical Center, said that the patients had a similar clinical picture, but weren’t falling into any pattern they had seen before, and that when a colleague from the National Institutes of Health mentioned levamisole, the researchers performed toxicity screens and all the patients were positive for cocaine.

Levamisole has been detected in cocaine since 2003, but the amounts have increased dramatically in recent years, according to the DEA. The inexpensive drug is being used as a diluting agent to stretch supplies. Levamisole is also known to increase amounts of dopamine, neurotransmitters that are involved in feelings of pleasure and euphoria, which leads experts to believe that it is also added to cocaine to enhance the user’s high.

Purpura occurs when vessels become plugged, blocking blood from flowing to the skin and leading to skin death and a purplish, crusty appearance. Cocaine itself also constricts blood vessels. It is not yet known how levamisole causes purpura, but the study authors said that both smoking and snorting contaminated cocaine can lead to purpura, and both men and women can be affected.

Steriods to prevent inflammation can be used to treat purpura, but the best treatment is to stop using cocaine. Mercurio said that once the patients stopped using cocaine, purpura improved.

Mercurio said that it is important to raise awareness of this condition among primary care physicians, adding that familiarity and recognition can help physicians quickly make a diagnosis and intervene.

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